Urgent CEA for Symptomatic Carotid Stenosis with Medical Treatment Resistance

S. Haga, Yutaka Fujioka, Yuhei Sangatsuda, Y. Kai, Y. Wakugawa, M. Yasaka, Y. Okada, S. Nagata
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Abstract

Summary: Background: The American Heart Association (AHA) recommends that carotid endarterectomy (CEA) be performed within two weeks in patients presenting with a symptomatic carotid stenosis. However, urgent CEA for acute stroke is not common because of medical resources. We carried out urgent CEA for patients with medical treatment resistance. The aim of this study was to determine the safety and benefit of urgent CEA with medical treatment resistance. Methods: Seventy-six consecutive patients underwent CEA at the Kyushu Medical Center between April 2007 and April 2011. Medical treatment resistance was diagnosed by repeat stroke or plaque diagnosis. Survival follow-up, NIHSS and the incidence of stroke were investigated all patients. Results: A total 15 patients in medical treatment resistance were enrolled. ICA stenosis was average NACET 56% (18 – 95%). The median days from event to CEA were 12 days (2 – 28 days). Plaque diagnosis suggested unstable plaque in all cases. There was no stroke recurrence in 30 days and no increase of NIHSS score, respectively. Conclusions: For the patients in medical treatment resistance, urgent CEA is associated with an acceptable outcome and satisfactory benefits. Plaque diagnosis is necessary to determine medical treatment resistance.
有药物治疗抵抗的症状性颈动脉狭窄的紧急CEA
摘要:背景:美国心脏协会(AHA)建议出现症状性颈动脉狭窄的患者在两周内行颈动脉内膜切除术(CEA)。然而,由于医疗资源的原因,急性脑卒中的紧急CEA并不常见。对耐药患者实施紧急CEA。本研究的目的是确定耐药的紧急CEA的安全性和获益性。方法:2007年4月至2011年4月在九州医疗中心连续接受CEA治疗的76例患者。通过反复卒中或斑块诊断诊断药物抵抗。对所有患者进行生存随访、NIHSS及脑卒中发生率的调查。结果:共纳入15例耐药患者。ICA狭窄平均NACET为56%(18 - 95%)。从事件到CEA的中位时间为12天(2 ~ 28天)。所有病例的斑块诊断均提示不稳定斑块。30 d内卒中无复发,NIHSS评分无升高。结论:对于耐药患者,紧急CEA可获得可接受的预后和满意的疗效。斑块诊断是确定药物耐药性的必要条件。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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